Piersantelli N, Casini-Lemmi M, Cavanna E, Cassola G, Crisalli M P, Guida B, Paladino M, Penco G, Piscopo R, Torresin A
Divisione Malattie Infettive, Ospedali Galliera di Genova.
Pathologica. 1992 Jul-Aug;84(1092):517-21.
We report on the occurrence of an uncommon pathogen, Rhodococcus equi (R.e.) in HIV infection. In the period february 1990-July 1991 we performed the diagnosis of R.e. infection (lung, lung-central nervous system) in two infected patients, aged 27 and 31 years, both males, drug addicts, classified as CDC IV. In the first of them an cavitating right bronchopneumonia (bpm) was diagnosed as of tuberculous origin, on the ground of the microscopic demonstration of an acid-fast, gram-positive strain in b.a.l.. A standard antituberculous regimen was uneffective and R.e. was eventually isolated in three blood culture taken shortly before the exitus and at post-mortem examination of the lungs. In the second patient a subclavian right bpm developed without microbiological evidence of any common pathogen. A third-generation cephalosporin course was only partially successful (clinical amelioration, incomplete clearing of radiological findings). After 3 months the patient relapsed and an aseptic meningitis developed. Cultures of blood and csf yielded a R.e. strain; post-mortem examination revealed a diffuse, cavitating bpm. Our personal experience underlines the difficulty in recognizing R.e. infections in compromised host, because of similarity to other entities (i.e. tuberculosis) and the absence of pathognomonic hints.
我们报告了在HIV感染中一种罕见病原体——马红球菌（R.e.）的出现情况。在1990年2月至1991年7月期间，我们对两名受感染患者进行了R.e.感染（肺部、肺-中枢神经系统）的诊断，这两名患者均为男性，年龄分别为27岁和31岁，是吸毒者，被归类为疾病控制中心IV级。其中第一名患者，基于支气管肺泡灌洗（BAL）中显微镜下显示的抗酸、革兰氏阳性菌株，最初诊断为结核源性的右肺空洞性支气管肺炎（BPM）。标准抗结核治疗方案无效，最终在患者死亡前不久采集的三份血培养物以及肺部尸检中分离出了马红球菌。第二名患者出现了右锁骨下BPM，没有任何常见病原体的微生物学证据。第三代头孢菌素疗程仅部分成功（临床症状改善，但影像学表现未完全消除）。3个月后患者复发并发展为无菌性脑膜炎。血液和脑脊液培养物培养出一株马红球菌；尸检显示为弥漫性、空洞性BPM。我们的个人经验强调了在免疫功能低下宿主中识别马红球菌感染的困难，这是因为它与其他疾病（如结核病）相似且缺乏特征性线索。
